Healthcare Provider Details

I. General information

NPI: 1861313231
Provider Name (Legal Business Name): JESSE GUEBLE LUCAS COLLIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11741 TELEGRAPH RD STE A-C
SANTA FE SPRINGS CA
90670-3681
US

IV. Provider business mailing address

11741 TELEGRAPH RD STE A-C
SANTA FE SPRINGS CA
90670-3681
US

V. Phone/Fax

Practice location:
  • Phone: 562-949-8455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: